THROAT
BACTERIAL PHARYNGITIS/TONSILLITIS = acute inflammation and infection of the throat or tonsils
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
VIRAL Hoarseness Sore throat Saline gargles
Adenovirus, Conjunctivitis Fever Lozenges
influenza, RSV, Runny nose Headache Analgesics
CMV, Cough/cold Anorexia Increase fluids
parainfluenza, Enlarged tonsils
EBV Cervical adenopathy
BACTRIAL Abdominal pain Penicillin 125-250mg q8hrs for 10 days
Group A strep (late Scarlitina rash (%00 mg bid if child > 60 lbs.)
winter/early spring) Strawberry tongue IM penicillin G benzathine
Neisseria + strep test (600,00 U if < 60 lbs., 1.2 mil U if > 60 lbs.)
gonorrhea (from Amoxicillin (25 mg/kg/dose, bid, 10 days) –
oral sex) better taste
Erythromycin or other 1st generation
cephalosporin if allergic to PNC
For Neisseria gonorrhea:
wt. < 45 kg : Ceftriaxone 125 mg single dose
wt. > 45 kg : Ceftriaxone 250 mg IM +
Azithromycin 1g PO
ACUTE NASOPHARYNGITIS (COMMON COLD) = acute viral infection of upper
respiratory system (usually involves nose, sinuses, middle ears, conjunctiva)
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
RSVmost common Dry cough, Sneezing Fever/Pain control w/ acetaminophen
Rhinorrhea/nasal congestion & ibuprofen
Overcrowding Irritability Saline nose drops
Sometimes low-grade fever Humidification
Decrease appetite Increase fluids
Headache Good hand hygiene
Clear lung sounds Should resolve on own in 1 – 3 weeks
RETROPHARYNGEAL AvuSCESS = Infection of tonsils forms into an abscess (lymph nodes most
common at age 3 but otherwise rare)
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
Staphylococcus aureus, Acute onset of high fever Emergency referral to ENT –
Group A strep Severe throat pain will need to be admitted
Usually proceeded by Drooling/difficulty swallowing to ICU if severe airway
URI, pharyngitis, Stridor obstruction→Will
sinusitis Neck hyperextension receive I&D and
Common at age 3 Noisy respirations IV antibiotics
PERITONSILLAR ABSCESS = Infection of tonsils forms into an abscess (any age)
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
Group A strep most common High fever Emergency referral to ENT –
Staphylococcus aureus, Severe throat pain will need to be admitted
Usually proceeded by Muffled voice to ICU if severe airway
URI, pharyngitis, Drooling/difficulty swallowing obstruction→Will
sinusitis Bad breath receive I&D and
Common at age 3 Unilateral tonsil enlargement IV antibiotics
Uvula displaced to unaffected side
CERVICAL LYMPHADENITIS (Cervical adenitis) = Inflammation/Infection effective cervical
lymph node (s)
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
Streptococcus Large unilateral cervical Treat empirically w/ oral antibiotics (dicloxacillen,
pyogenes, Staph mass > 2-6 cm that is amoxicillin clavulanate or cephalexin) for min 10 days
ylococcus aureus tender on palpation Cold compress
Mycobacterium Swollen neck Fever/Pain control w/ acetaminophen & ibuprofen
tuberculosis Fever Reevaluate in 36 to 48 hours – if no improvement or
Stridor, hoarseness worsening refer to ED for hospitalization & ENT consult
EPIGLOTTITIS = Severe rapid inflammation/swelling of supra-glottic structures
ETIOLOGY SIGNS/SYMPTOMS MANAGEMENT & TREATMENT
Group A Acute onset of high fever Do not attempt to visualize suspected
Streptococci Severe throat pain Provide CPR and oxygenation while
pneumococci, Muffled voice emergency transport arrives and can
Haemophilus Drooling/difficulty provide nasotracheal intubation
influenza swallowing & breathing Radiograph shows “thumb sigh”
Neck hyperextension Will be placed on IV antibiotics for 2-
Leaning forward with 3 days, discharged on 10 day course
chin thrust forward Corticosteroid to reduce swelling
Respiratory distress
